FIGURE 8.1. The normal femoral head. (The copyrights for all the illustrations in this chapter are retained by Dr. Villar.)

FIGURE 8.2. Softening of the femoral head cartilage with initial fibrillation.

ness of the articular cartilage on the anterolateral portion of the femoral head.6 Normal hyaline cartilage, as in other joints, has a shining white appearance on direct inspection (Figure 8.1). When using the 70-degree arthroscope, it is possible to visualize approximately 80% of the articular surface. This view is simplified by rotating the leg during the procedure. Anteriorly, the cartilage extends on the femoral neck for a short distance, which is thought to be a reaction to the pressure from the iliopsoas tendon crossing the joint in this region. The spherical shape of the head of the femur does not ease the orientation within the joint. The only fixed landmark on its surface is the insertion of the ligamentum teres on the fovea. This area is located on the anteromedial portion of the head and was previously known as the bare area. Because of deformation and magnification, it is not always possible to detect abnormalities of the overall shape of the head. However, damage to the hyaline cartilage is clearly and easily seen. The consistency of the articular surface can also be assessed with a probe and is usually indentable (Figure 8.2).


The name acetabulum comes from the Latin and means vinegar cup from the similarity in shape with this article from ancient Rome. To the arthroscopic surgeon it appears horseshoe shaped, encircling the ac-etabular fossa, the lunate surface. It can be divided into a superior part, an anterior column, and a posterior column. The classic theory says that no evidence of the existence of the triradiate cartilage is considered to remain in the adult hip. At this stage, the anterior one-fifth of the acetabulum is formed by the pubis, the posterosuperior two-fifths by the ilium, and the posteroinferior two-fifths by the ischium. The normal surface appears white, smooth, and glistening. The thickness of the articular cartilage is reported to be maximal on the anterosuperior quadrant.6 With the


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Essentials of Human Physiology

Essentials of Human Physiology

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